HIV prevalence among the biggest ethnic groups of MSM in Estonia: results of a pilot comparative study
The article is devoted to the problem of inequality between the largest ethnic groups (Estonians as the majority and Russians as the minority) exacerbarated by Russian invasion of Ukraine in 2022.The aouthors start with the hypothesis that Ukrainian men who have sex with men (MSM) in Estonia, as a socially and economically vulnerable group, bear a greater burden of HIV infection compared to local MSM. The article aims to compare the prevalence of HIV infection and potential associated social factors among Ukrainian MSM in Estonia, in comparison to local MSM. The authors propose to develop the more targeted design of medical and social services for refugees and migrants, serving as one element in reducing existing ethnic inequality within society. The article analyses the clients’ records of the MSM Checkpoint project of the Estonian Network of People Living with HIV (PLWH) from which data such as age, region of residence, nationality, and (if migrants or refugees) country of origin are taken. Biological results were obtained through free and voluntary testing using the Insti Rapid Detection HIV Self Test. If the test was positive, the client was referred to an HIV clinic. Uni and bimodal distributions as well as binary logistic regression were used in the data analysis. Voluntary counselling and testing was conducted with 2766 MSM in Estonia. The article states that HIV prevalence rate among all MSM was 4% (79% were receiving antiretroviral therapy (ART)), and among Estonians, Russians, and Ukrainians it was 3%, 6%, and 8%, respectively. The results demonstrate that despite the different ethnic composition of the regions of Estonia, Russians living compactly in the most HIV-affected Ida-Viru county do not differ from the Estonian majority in terms of HIV prevalence, whereas HIV is more widespread among Ukrainian MSM, which indicates the need to create health services for war refugees in Estonia. After comparing our data with Estonian and Ukrainian state statistics, as well as data from scientific literature, the authors conclude that the higher HIV burden among Ukrainian MSM in Estonia appears to be driven by two primary factors: 1) uncontrolled HIV epidemics in the occupied regions of Ukraine, and 2) the challenging circumstances faced by war migrants, which include intersectional stigma and discrimination. Furthermore, the authors argue that the state should prioritise the collection of crucial strategic information on HIV key populations, paying particular attention to ethnicity.
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